1. The Urban Health Intervention
UGSPH Status Report on GEHIP for Ga
East District
Philip Adongo, PhD

2. Outline of presentation
1) URBAN CHPS:
• Milestones in setting up CHPS in Rural areas:
Activity: Assessing the relevance of the CHPS process to an urban setting
(Year 1)
• Results: Clarification of how urban CHPS differs from Rural CHPS
2) THE LEADERSHIP COMPONENT OF HEALTH SYSTEMS STRENGTHENING
• Leadership Programme:
-- MPH health systems development component
• District leadership development
--Modular training component
3) PROGRESS WITH LAUNCHING THE BASELINE SURVEY IN GA EAST AND GA
WEST

3. Activity I: Preparation for Urban CHPS
CHPS Programme Milestones
Questions that we addressed:
• Are the rural milestones relevant to the urban
environment?
• How are urban CHPS service operations different from
rural operations?
The milestones are:
1) Community engaged planning (Community Health Committee, zoning, mapping, etc)
2) Community entry (liaison with traditional and opinion leaders). Developing participatory
implementation.
3) Community Health Compound development (construction, renovation, or rental)
4) Essential equipment procurement.
5) Nurse orientation to community work and posting to Community Health Compounds
6) Volunteer identification, recruitment, training and deployment

4. Community Entry
Strategy assessment for Urban CHPS
Formative Research:
1. Focus Group Discussions (FGDs)
2. In-depth interviews with stakeholders and opinion
leaders
To seek views on
– Health seeking behavior for child and maternal health
– Health decision making at local level
– Community conceptualization of Urban CHPS
– Potential models of CHPS

5. Milestone #1:
CHPS Planning
Urban versus Rural Model
• Urban CHPS
– Large populations
(20,000-40,000)
– Zoning is required and it
is important exercise
– Difficult to mobilize
community to contribute
– Nurses may need to
concentrate on
promotion activities
• Rural CHPS
– Small population (3000-
5000)
– Zoning is easier
– Easy to mobilize
community to contribute
– Curative aspects very
important

6. Milestone #1:
Zoning of Ga East into CHPS areas
All four Ga East sub-districts were
“zoned” for CHPS including….
–Dome
– Danfar
– Madina
– Abokobi

7. Milestone #1:
Selection of start up CHPS zones in Ga East
Zones Area covered Estimated total
population
Estimated no. of
chn 0-59m
Estimated no. of
household
One Rabit, Auntie Mary,
Ohenho etc.
23,282 4,191 1,219
Two Dome market,
Dome Park,
Grushie Town etc.
41,169 7412 966
Three CSC, GYM, Atomic,
Atomic Ayigbe
Town etc.
18,894 3400 729

12. Milestone #2: Urban Community Entry
Sensitization meetings with the SPH, Region and Districts
• Discussions with regional health administration
• The forum to has been created where GEHIP has
been presented to the
– School of Public, University of Ghana
– All MHMTS, DHMTs
– GA East
– The Assemblies-Discussions with planning
officers of Ga East (intervention area) and Ga
West (comparison area)

13. Milestone #3
Procurement of work space or clinic
• Municipal Assembly
providing storage space for
equipment, but
construction of a
“Community Health
Compound” may present a
challenge
• Partnership with private
health providers to provide
space
• Municipal Assembly to
providing space for the
GEHIP field office in Ga
East.

14. Milestone #4:
Essential equipment
Health workers
needs small
Vehicles to
conduct their
activity

15. Milestone #5
The Training of CHOs
• TOT training completed in Mid September:
• Training of CHOs started in October, 2010
– GEHIP is supporting the training of CHOs

16. Milestone #5: CHO deployment
The way forward for urban CHOs…
• A non-residential service
• Collaborate with private health institutions
• We will learn from experience on in-service
training for urban CHO.
– Innovation in communication (ways to replace
durbars)
– May have to make modifications during our
“Phase 2” implementation process

17. Milestone #6
Volunteers
– Volunteer identification, recruitment, training and
deployment

18. Milestone Rural CHPS Urban CHPS
1) Community -
based Planning
Situation analysis, initial outreach to chiefs,
“zoning” of catchment areas.
Block and neighborhood
identification, clarification of
geographic responsibility
2) Community entry • Building understanding with chiefs, elders,
& opinion leaders.
• Developing Community Health
• Organizing CHC action
• Developing durbars for health
communication
• Focus on identifying social
networks (corresponding to
ethnicity of settlers).
• Outreach to formal authorities
& politicians
3) Essential
equipment
Motorbikes & bicycles
+ clinical equipment for IMCI, EPI, FP/RH
Low cost 3 or 4 wheel vehicles
+ clinical equipment for IMCI, EPI,
FP/RH
4) Facility
development
Community volunteer construction of CHC or
renovation of existing facility
Arranging donation of secure
space or renovation of donated
space. No CHC
5) Nurse community
engagement
training & posting
Training in community entry, liaison, and
sustaining community participation
Training in health education in the
urban context
6) Volunteer
identification,
training, &
deployment
Community organizational focused
Basic medicinal products distribution
(Major role in health promotion: bednet
promotion, condoms, ORS, etc.)
Service focused volunteers with
no curative services.
(Limited role)

19. Activity II
Developing a Leadership Programme
• Develop BPH/MPH Training that prepares
leaders for District Health Management
--Utilize GEHIP sites for MPH field practica
in health systems development
-- Two or three MPH students will be working on
Urban CHPS in the Ga East Municipal
• Develop field model to be used to strengthen
both rural and urban CHPS through modular
“peer” training in systems development

20. The Problem:
Existing training produces tiers of capable individuals,
but not systems capacity building….
Community Health Officers
Supervisors, Disease Control
Officers, Nutrition, etc.
Registered nurses, midwives
District Directors & Health Management
Team members

21. The School is now contributing to Public Health
Capacity Building at all levels of the system
Community Health Officers
Supervisors, Disease Control
Officers, Nutrition, etc.
Registered nurses, midwives
District Directors & Health Management
Team members
A critical component:
Bachelor of Public Health for
supervisors, paramedics,
nurses, etc.

22. Pathways of the BPH course
• Public Nursing
• Disease control
• Health promotion
• Environmental health
• Health information

23. With GEHIP support, the UGSPH has
formed a health systems development
partnership with the GHS:
Short public health system training modules on health
systems development themes that require teamwork
across levels
Practical peer demonstration in GEHIP districts.

24. With GEHIP support, the UGSPH has
formed a health systems development
partnership with the GHS for
developing public health system
modules that require teamwork across
levels…

25. What will GEHIP Add?
Community Health Officers
Supervisors, Disease Control
Officers, Nutrition, etc.
Registered nurses, midwives
District Directors & Health Management
Team members
CHPS
development
Peer Leadership
Training

26. What will GEHIP Add?
Community Health Officers
Supervisors, Disease Control
Officers, Nutrition, etc.
Registered nurses, midwives
District Directors & Health Management
Team members
GEHIP District
Health Profiling &
DiHPART
implementation

27. What will GEHIP Add?
Community Health Officers
Supervisors, Disease Control
Officers, Nutrition, etc.
Registered nurses, midwives
District Directors & Health Management
Team members
Information for
Decision-
making

28. MPH component of
Leadership Training pretested in Ga East:
• Participation in Ga-East Municipal Annual Review
Meetings
• Ga East Project (SPH & NOGUCHI) 14 MPH
dissertations, all with health systems plus focus
topics on ....
– Health financing, planning
– Nutrition
– Oral health
– Reproductive health, sexually transmitted diseases
– Quality of care.

29. Activity III.
Preparations for the Baseline Study in Ga East
• Draft questionnaire developed for Household surveys
• Household surveys in Ga East & Ga South to obtain
information on …..
– Household characteristics
– Pregnancy history
– Contraception
– Antenatal care
– Delivery & newborn care
– Health seeking behaviours
– Malaria & use of ITNs
– HIV/AIDS & other STIs
– Cost of health services

30. Thank you very much